Simulation Training in Cardiothoracic Surgery: An Essential Requirement for Future Training Programs?

Standard cardiothoracic surgical training programs are still based on the apprentice model. It implies that registrars in all programs will attain surgical competency in addition to theoretical training fulfilling minimum statutory requirements for licensing and independent practice. It is highly dependent on surgical volumes, attitude of trainers and perceived surgical ability of the trainee. At best, it produces a mixed bag of competency levels.

Well designed integrated interdisciplinary simulation programs offer an alternative that allows for deliberate practice in an organized step-wise progression model, with inbuilt assessment and feedback systems. This allows for proficiency training rather than competency training in which clear objectives can be met.

The University of the Free State (UFS) program (Fig. 1), is being designed as a hub and spoke model for South Africa (SA) and sub-Saharan Africa (SSA), combining distance learning with an on-site high fidelity simulation and assessment center. Off site training in crew resource management or CRM (which addresses communication, decision making, team building and maintenance, workload management and situational awareness management), educational theory, surgical theory and basic bench model simulation will be provided. Feedback and assessment per session are pre-requisites for attending high fidelity and virtual reality simulation sessions at the UFS simulation center.

Figure 1

The concept program was assessed during simulation sessions at the annual registrar symposium in April 2017 attended by 44 registrars/consultants and 21 perfusionists from SA and SSA. Participants (91%) agreed that simulation programs should be available to trainees and surgeons. Systems considered absolutely necessary were bench models (89%), virtual reality models (77%), human performance (80%) and 83% agreed that assessed procedures should contribute to training case requirements.

The development of integrated interdisciplinary simulation programs is essential for proficiency development through deliberate practice and should become a statutory requirement for future trainees